Medicare allows CCRCs to bill CCM and RPM concurrently, creating dual revenue streams exceeding $100 monthly per qualified resident. However, strict separation of services and meticulous documentation requirements determine whether your facility maximizes reimbursement or faces costly audit findings.Learn more: https://ccmrpmhelp.com/contact
Here's the question that keeps CCRC administrators up at night: Can we actually bill Medicare for both Chronic Care Management and Remote Patient Monitoring in the same month for the same resident? The short answer is yes, but there's a catch that could cost you thousands if you get it wrong. Medicare explicitly allows continuing care retirement communities to bill CCM and RPM together during the same thirty-day period. This isn't some gray area or loophole. The Centers for Medicare and Medicaid Services designed these programs to work together because they serve completely different purposes in patient care. But here's where most facilities stumble. The services and time spent on each program must be entirely separate and distinct, with absolutely zero overlap. None. If you're counting the same twenty minutes toward both programs, you're violating Medicare rules and setting yourself up for an audit that could trigger repayment demands. Let's break down what makes these programs different. Chronic Care Management is all about coordination. Your staff spends time scheduling specialist appointments, resolving medication prior authorizations, updating comprehensive care plans, and making sure every provider involved in a resident's care stays on the same page. They're also ensuring patients have access to emergency support around the clock. It's the behind-the-scenes work that keeps complex medical situations from falling through the cracks. Remote Patient Monitoring operates in a completely different lane. RPM centers on collecting and analyzing physiologic data from connected medical devices. We're talking blood pressure readings, blood glucose levels, oxygen saturation, weight measurements. The work involves reviewing transmitted data, spotting concerning trends, and having conversations with residents specifically about what those numbers mean for their health. When a resident's blood pressure spikes three days in a row, that's RPM territory. When you're coordinating their follow-up cardiology appointment, that's CCM. The beauty of combining these programs is that they create a safety net for your residents. Daily data alerts your staff to emerging problems between scheduled check-ins. Research shows this dual approach reduces hospital readmissions and helps residents maintain independence longer, which matters tremendously when avoiding acute care transfers directly impacts quality of life. Now let's talk about the compliance piece because this is where facilities get into trouble. The single most important rule involves maintaining completely separate time logs for each program's activities. Your staff needs systems that record the date, duration, and specific activity performed, clearly showing which program code the work supports. Vague documentation like saying someone spoke with a patient for twenty minutes, creates audit vulnerabilities. You need details proving the work was distinct. For RPM documentation, you're specifying which device generated data, how many days of readings were reviewed, what the measurements showed, and exactly what you discussed with the resident about those specific numbers. For CCM documentation, you're detailing which providers you contacted, what information got exchanged, what appointments you scheduled, or how you updated the care plan. The difference must be immediately apparent to anyone reviewing the medical record months or years later. Both programs also require an initiating visit with the rendering provider for new patients or those not seen within twelve months. During this appointment, you need to discuss both programs if the resident qualifies, explain what participation involves, and address any cost-sharing responsibilities. Patient consent must be obtained separately for each program and documented clearly before any billable services begin. You cannot assume consent, backdate it, or bundle it together. Here's what makes residents eligible for each program. Chronic Care Management requires at least two chronic conditions expected to last twelve months or until death. We're talking serious conditions like diabetes, heart disease, COPD, dementia, or chronic kidney disease. These aren't minor health concerns but conditions demanding regular coordination between multiple providers. Remote Patient Monitoring has broader eligibility since it works for patients with either chronic or acute conditions requiring physiologic data collection. A resident recovering from heart surgery might use RPM temporarily, while someone with hypertension uses it long-term. Many CCRC residents naturally qualify for both programs simultaneously because they're managing multiple chronic conditions that benefit from coordination and continuous monitoring. A resident with diabetes and heart failure needs someone coordinating their endocrinology and cardiology care while also watching their daily blood sugar and weight measurements for early warning signs. This overlap creates significant opportunities for retirement communities to implement combined programs that address their population's needs while generating sustainable revenue streams. The financial opportunity here is substantial. A single resident meeting all monthly requirements generates combined reimbursement exceeding one hundred dollars from foundational codes alone, before counting additional time that complex cases might require. This model works particularly well for CCRCs because your resident populations typically include many individuals with multiple chronic conditions who benefit tremendously from both services. Unlike traditional office-based practices, these programs reimburse for work happening where residents already live. Your staff can check in during normal routines and coordinate care without logistical challenges. If you're ready to implement concurrent billing successfully, start with one program before adding the second to avoid overwhelming your staff. Beginning with CCM establishes coordination workflows and documentation practices that later support adding RPM for appropriate residents. Start small with a pilot group of residents who clearly qualify for both programs, allowing your staff to develop confidence with the requirements while limiting initial risk. Click the link in the description for a complete implementation guide that walks you through documentation requirements, CPT codes, and compliance strategies that keep your facility audit-ready from day one.
CCM RPM Help
City: Herriman
Address: 12953 Penywain Lane
Website: https://ccmrpmhelp.com/
Phone: +1 866 574 7075
Email: brad@ccmrpmhelp.com